Page 39 - WJOLS - Surgery Journal

World Journal of Laparoscopic Surgery, January-April 2009;2(1):40-41
Alaa Bakir Raheem
Laparoscopic versus Various Types of Open

Ligation of Testicular Veins for Treatment of

Varicocele

Alaa Hatem Abdulkareem
General Surgeon, Al-Karkh Hospital, Baghdad, Iraq

Abstract PATIENTS AND METHODS
Varicocele therapy is controversial issue with no single approach
adopted as the best therapeutic option. Patient were divided into The study included [256] patients divided into 2 groups. Group
groups which received 2 different modalities of treatment [namely 1 [164 patients] referred to general and pediatric surgery
high ligation of testicular veins, Paloma operation and subinguinal department for LVL. Group 2 [101 patients] referred to urology
microscopic varicocelectomy [SMV] and compare them with department for SMV and paloma operation. The age of the
laparoscopic varicocele ligation [LVL]. Group 1[164 patients] treated patients in group 2 ranges between 8-24 years [average of 24.4
with LVL. Group 2 [101 patients] treated with open method [65 years.]. Those in group 1 were between 8-39 years [average
patients with paloma and 36 patients with SMV]. Group 1 showed 21.3 years]. The majority of school aged patients were
less recurrent rate [4%] vs. [8%] for group 2. Less hospital stay for asymptomatic and disease discovered during routine medical
group 1 [1.3 days] vs.[3.5 days] for group 2. Return to normal activity
was shorter in group 1 [4.5 days] vs. [9 days] in group 2. More examination. While testicular pain and/or swelling were the main
costeffective for group 1 patients than group 2. complaints among patient aged 15-25 years, subfertility was
Keywords: Laparoscopy, varicocele, paloma high ligation, LVL the major presentation among those above 25 years age .The
(laparoscopic varicocele ligation), SMV (subinguinal microscopic diagnosis of varicocele was established mainly by clinical
varicocelectomy). examination with patient in upright position. The disease was
Aims and objectives: The aim of this study was to compare the graded according to criteria published by Lion et al. In majority
effectiveness and safety of laparoscopic and conventional methods of patients, the varicocele was grade 2 or 3.
(open technique) in the treatment of varicocele. The following • 62 patients in group 1 had left sided varicocele.
parameters were evaluated for both laparoscopic and open procedures. • 109 patients in group 2 had left sided varicocele.
1. Operative technique • Bilateral varicocele was present in 3 patients group 2.
2. Patient selection • Bilateral varicocele was present in 19 patients group 1.
3. Operating time
4. Postoperative complications including recurrences Doppler U/S was done in all patients to confirm diagnosis
5. Hospital stay and to evaluate testicular size pre and postoperatively. Seminal
6. Cost-effectiveness. fluid analysis was performed preoperatively for male infertility
Material and methods: A literature search was performed using medline cases and repeat it postoperatively every 6 months for 18-24
and other search engines, the following search terms were used months.
[laparoscopic versus open methods in treatment of varicocele]. Criteria
for selection of the literature were no. of cases, methods of analysis RESULTS
operative time and institution where the study was done.
• In group 2 average operative times was
INTRODUCTION – 38 minutes for unilateral cases.
The prevalence of varicocele in adolescence is equivalent to – 70 minutes for bilateral cases.
that of general male population [average of 15%] where as before • In group 1 average operative time was
1,2
puberty varicocele is rare. The incidence of varicocele in male – 58 minutes for unilateral cases.
patient with infertility is approximately 40%. 3,4 Varicocele can – 75 minutes for bilateral cases.
negatively and progressively affect testicular growth , histology, • In group 2:
5
function resulting in progressive decline in fertility. 50-60% of – 65 patients had paloma operation of which 9 patients
male patients treated for varicocele show improvement in semen had recurrence [13.8%].
3
quality. In the last few years varicocelectomy has been – 36 patients had SMV operation of which 4 patients had
performed by laparoscopy. 6 recurrence [11%].
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